DEP/DUA/1/15/15 (Normalised version)

Janet McKenlie

(1777-1778)

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Janet McKenlie.

A case respecting nature of which much divided in opinion between two suppositions.

And these to considerable degree affect both practice & prognosis.

Here principle complaint of patient consists in cough & dyspnoea.

This attended also with general debilitated appearance of exhausted habit, & expectoration to considerable extent of viscid yellow matter.

All these known to be symptoms of that affection very fatal about period of life to which this patient arrived Phthisis.

But occurs also in affections [merely] catarrhal.

And when that the case danger much less considerable.

Treatment also in some particulars varied.

Especially where as in present instance is supposed ultimately to proceed from another affection.

For here will observe that all complaints of patient ultimately referred to obstruction of menstrual.

This circumstance however may have influence as inducing either one or other of affections [mentioned]

Or independent of this either one or other may occur merely as concomitants of obstruction of menstrual discharge.

And may have arisen from action of same cold upon surface to which interruption of natural course of that evacuation ascribed.

But if distinction between catarrh & Phthisis of importance in practice not less useful as [leading] to proper judgement in prognosis.

When catarrh recent or phthisis far advanced certain judgement may be easily pronounced.

But frequently transitions from one to other.

And very difficult to distinguish with certainty during intermittent stages.

Such an instance now occurs in case before us.

Here no one symptom or combination of symptoms on which absolute dependence can be put.

Every particular occurring in the disease as far as can be derived from history given us, may be merely catarrhal.

At same time, when consider insidious nature of Phthisis pulmonalis have grounds for suspecting that may already have made considerable advances.

And must own that am rather disposed to believe this may really be case.

Here one particular which if certainly ascertained would put question beyond all doubt.

That is peculiar nature of matter expectorated.

In history of affection is [described] as of yellow colour.

And may probably from circumstances of general connection presume that not of very fluid consistency.

In this state then has general appearance of two fluids in nature very different Pus & [Mucus]

If however in any degree of former is to be considered as certainly Phthisic.

If entirely of latter may be catarrh.

Must indeed be admitted that vomica may exist in lungs from which no discharge.

And these although matter at present expectorated purely mucus yet patient may in reality be subjected to Phthisis.

When this however the case for most part cough without expectoration.

And especially when as in instance now before us is attended with fixed pain.

If then matter expectorated merely mucus probable that disease entirely catarrhal.

And on this ground all symptoms may readily be explained.

But if in expectorated matter even mixture of pus are without any hesitation to [pronounce] affection certainly phthisic.

Must then appear that for all such calls an accurate distinction between pus & mucus of greatest utility.

For this purpose in writings of medical practitioners many different marks pointed out.

And besides general appearance of fluid expectoration its colour, taste, smell, particularly on [burning] but above all specific gravity pointed out as distinguishing marks.

The last chiefly ascertained by observing whether sinks or swims in water.

And this perhaps, especially as tried by Hippocrates, one of best

While pus sinks in water, mucus usually swims.

And if in place of common water we employ as was done by Hippocrates salt water or [use] mixture of salt & water test less doubtful.

But in any way by no means a certain mark.

For mucus in reality a fluid specific gravity of which greater than that of common water.

And only observed to swim in consequence of having air attached to it.

Same also may happen of very viscid pus.

Thus then while mucus entirely freed from air bubbles will sink, pus by aid of these may rise to surface.

This uncertainty in common means of distinguishing these fluids induced a [Society] of medical practitioners here to which I have the honour to belong to proposed the discovery of proper test as subject of prize medal.

And is with particular pleasure I can now inform you that their intention has not been frustrated.

At least among other tests one is proposed which if experiments accurate, will put this matter beyond all doubt.

And if same chemical [relationship] hold with regard to other pus & mucus as with that employed in experiments to which allude may be able to say with certainty whether [expectorated] matter does or does not contain any mixture of Pus.

Who is author of this dissertation will not be known till letter which accompanied it be opened.

And this will only be done if the prize shall be adjudged to it.

But whether the other Gentleman on whose sentiments this must depend shall be of same opinion with me or not apprehend shall [naturally] rob this author of gain or reputation by now mentioning his test.

Especially as period allowed for receiving farther dissertations now elapsed.

Test which he proposes is by aid of Caustic alkali Lixivium & of Vitriol acid.

By either of these according to his experiments certain determination may be formed.

From experiments & deduction which constitute greatest part of this dissertation he concludes that if any one has expectorated matter contents of which he wishes to ascertain let him dissolve a portion of it in Caustic Alkali Lixivium or Vitriol Acid.

Let him add pure water to both solutions.

And if mixture remains [limpid] is evidence that fluid expectorated merely mucus.

But if in both cases an evident deposit of matter to bottom of vessel is certain test that expectorated matter contains pus.

Since read this dissertation have had one opportunity of putting this test in practice.

Not indeed with matter expectorated by present patient who lives at distance from Edinburgh but with another under our care. viz Ann Mason of whom shall afterwards speak.

From this trial both disposed to conclude that test a good one & to pronounce in that case a very unfavourable prognosis.

Matter [recorded] of white colour, of [thick] consistency & very considerable degree of viscidity.

Much greater indeed than commonly case with pus.

Was however as far as I could discover without manifest offensive or foetid smell.

And did not even show such on burning.

Dissolved portion of it in Caustic Alkali and another portion in vitriol acid.

For this solution space of some hours with agitation at times was requisite.

And after all though apparently [intimately] combined yet in both considerable viscidity.

On addition of water, in both solutions very considerable sediment fell to bottom.

And in that with vitriol acid besides this deposit a matter rose to surface

An appearance which by way may observe is remarked to happen in dissertation to which have alluded where pus & mucus united.

From these trials then led to conclude that in present case expectoration to considerable degree purulent.

In conferment of trial wished to see how far common test gave evidence of pus.

And found that when part of this matter put into pure water in very short time sunk to bottom.

To see also what would be affect of mucus in circumstances in which had put the matter expectorated by our patient dissolved some of it in caustic alkali obtained by being blown from nose.

On addition of water solution perfectly clear & without sediment

From these circumstances then led to conclude that test proposed a good one

And that the matter which had examined contained considerable proportion of pus.

Have not yet had opportunity of trying in this manner the matter expectorated by present patient.

But hope that may have it in power to examine it before next lecture.

And shall then present with result of trials together with what farther observations have to offer on this case